Meningitis in newborns: causes, danger, symptoms and methods of prevention. Purulent meningitis in newborns

Meningitis in a newborn is a bacterial inflammatory disease. It manifests itself in the brain and has a lot of negative consequences. The disease is very common among children of the first year of life and 50% of them do not survive. In this article, we will look at how to prevent an insidious disease and whether it is possible to cure it.

After birth, 1 in 10,000 babies is diagnosed with meningitis. This disease has several varieties, depending on which doctors prescribe treatment for the child:

Viral meningitis in children under one year old is characterized by difficult diagnosis. The absence of symptoms can be life-threatening for a child. Usually, infection occurs due to exposure to the chickenpox virus or rubella measles.
Fungal meningitis occurs in children born prematurely or with risk factors for immunodeficiency pathology. A child can acquire this type of disease directly in the maternity hospital if hygiene rules are not followed.
Bacterial meningitis in infants occurs due to the penetration of the baby pneumococcus or meningococcus into the body.
Tuberculous meningitis among newborns is quite common in recent years. Such a disease appears with characteristic signs: high fever, vomiting, loss of consciousness.

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- Can we talk about it not on this day?
He left. After a while, my daughter (6 years old) tells me:
- Mom, he's hopeless!

Each type of damage to the nerves of the brain in a child requires adequate treatment, since the lack of therapy is fraught with child death.

Watch a video about the symptoms of meningitis in babies.

Meningitis in a newborn: symptoms and diagnosis at home

Meningitis is an infectious lesion of the membranes of the brain of a newborn, while creating a high. If the disease is not treated, there are dangerous consequences. And you can determine the dysfunction of the brain of the baby, knowing the following indicators:

body temperature rises sharply or unreasonably decreases;
there is heavy breathing (but not in all sick newborns);
muscle spasms and spasms in the cervical region are manifested;
facial expressions change, bulging or sunken eyes are possible;
vomiting, regular regurgitation, anxiety and headaches;
the baby's body acquires a yellow tint, which is associated with the progression .

Attention! You can determine the presence of meningitis in newborns by a convex fontanel. Therefore, parents should be careful, especially if the child was born weakened.

Also, the child may be disturbed by soreness of the muscles of the cervical region. It is painful for him to turn his head, as meningitis often affects the nerve endings of the eyes, neck and face. By similar symptoms, you can diagnose the disease in a newborn without medical help.

Medical treatment of neonatal meningitis

Children's meningitis is a very dangerous phenomenon. Therefore, its treatment must begin strictly with the collection of tests to determine whether it is really bacterial meningitis. To neutralize pathogenic bacteria that develop in the cerebrospinal fluid of the body of a newborn, injections of antibacterial drugs are prescribed. For each child, the medicine is determined individually, depending on the age and possible intolerance of its components.

If the newborn periodically loses consciousness, he must be hospitalized, since the treatment of the disease at home may be ineffective. In addition, meningitis caused by streptococcus carries a lot of complications, up to death. With more favorable prognosis, treatment of headaches after meningitis is required.

Secrets of the folk treatment of meningitis in infants

We draw the attention of parents that it is permissible to treat meningitis in newborns with herbs only as an addition to medical medicine, and not instead of it. Be sure to use traditional medicine recipes should be supervised by a doctor.

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- People, machines, - then he looked at the sky: - and moons, do well!

Viral meningitis in a newborn (manifested after chickenpox or rubella) is treated with linden decoction. It should be given to the child three times a day for 0.5 cups. Make tea warm and let's drink to the baby through a bottle with a nipple.

Treat bacterial meningitis with a decoction of dried lavender flowers. The child is given one glass of this drink in the morning before feeding and in the evening before going to bed, also through a bottle.

Attention! Folk remedies for abscess(meningitis) in infants not only help increase the chance of a successful recovery, but also increase the immunity of the crumbs.

Causes of purulent childhood meningitis

Purulent meningitis among children is spreading very rapidly. The causes of the disease are:

transmission of Coxsackie viruses by airborne droplets (when coughing, sneezing);
by contact (if an infected person touches a newborn);
an epidemic of viral parotitis;
penetration into the body of Escherichia coli;
sepsis causes secondary purulent meningitis in infants.

In older children - from one to six years - purulent meningitis may occur as a complication after otitis media and diseases of the sinuses. Therefore, doctors recommend protecting your child from colds and contact with strangers until immunity is strengthened.

To date, medicine is not omnipotent in the fight against brain abscess in newborns. In this regard, some children die, unable to cope with the disease.

What is the likelihood of the consequences of meningitis? Significant risks

If the symptoms of the disease have worsened and become permanent, it is likely that the infection has spread throughout the child's body. Even with proper treatment, there is a risk of complications:

newborns show hydrocephalus;
complete or partial deafness develops;
possible development of strabismus;
characterized by a delay in mental and physical development.

In more difficult situations, the child remains disabled, the likelihood of poor blood clotting increases.

How to avoid the consequences of meningitis is described in this video.

REFERENCE! Meningitis in infants occurs in 1 out of 100 children, most often children who are under one year old are affected. Half of the patients die.

The first signs in infants up to a year

During the incubation period of meningitis in infants, there are signs:

headache, pain of a bursting character;
body temperature rises;
the child is sick and vomits;
the baby is weak, lethargic;
drowsiness;
skin is unnaturally pale;
the body breaks;
intolerance to bright lights and loud sounds;
constant, high-pitched crying.

When the disease begins to develop, the temperature in the infant rises quickly. For 3-4 hours it rises to 40 degrees. With timely measures taken, the temperature drops on the third day.

Headache in the forehead, eyes, nose. At elevated temperatures, nausea and vomiting begin. The cause of vomiting is that the vomiting center of the brain swells. Vomiting is not related to food, the child begins to vomit when he is turned over or the headaches increase.

Symptoms of meningitis in an infant

The child refuses to eat, the respiratory rhythm is changed, he suffers from convulsions. Consciousness is lost, the fontanel is compacted. Fever, poor appetite and vomiting do not yet indicate that this is meningitis. Such signs are characteristic of other diseases. An accurate diagnosis is made if there are the following symptoms of meningitis in infants:

The occipital muscles numb.
Buccal symptom.
Muscles are tense.
The baby lies on its side, head thrown back and knees bent to the stomach.

What to do if there are warning signs of the disease?

If a child under one year old has symptoms of meningitis, an ambulance team is quickly called. Only the doctor knows what measures to take for. You cannot act on your own.

Why is self-medication dangerous?

Alternative methods of treatment are unacceptable. The disease is acute, passes with lightning speed. The immune system of the baby itself is not able to cope with the pathology, they will not bring a positive effect.

Self-medication with medications is also dangerous. There are drugs that are incompatible with other drugs. The dosage of the drug depends on the weight of the child, only the pediatrician determines this accurately. The duration of taking medications is determined by the doctor.

IMPORTANT: incorrectly selected medications lead to disorders of the gastrointestinal tract. The child is sick, problems with a chair, the stomach is swollen.

If you do not start traditional treatment in a timely manner, there are:

excess fluid accumulates in the brain;
intoxication of the body leads to toxic shock;
the brain swells;
hearing deteriorates.

The reasons

The immediate cause of the disease in children at any age is infectious agents. Common:

viruses;
fungi;
bacteria;
toxoplasma (protozoa).

At different ages, different microbial agents influence the development of the disease.. There is a rule:

In newborns, the disease is formed as a result of intrauterine infection. It is passed on to the fetus from the mother. Herpetic or toxoplasma infection.
In infants, meningitis is a sign of congenital syphilis or HIV (combination with other infectious signs).

Risk group:

Important! The main cause of the disease is a weak children's immunity.

Conclusion

To prevent complications, a full treatment course is completed. After all signs of meningitis in infants have disappeared, treatment lasts another 2-3 weeks until complete recovery. Immunomodulators are taken, blood and urine tests are repeated. The risk of relapse is high.

Meningitis is a severe infectious disease characterized by inflammation of the lining of the brain and spinal cord. It occurs both independently and against the background of other infectious diseases.

No one is safe from meningitis, but children under 5 years old, young people aged 16 to 25 years old and older people over 55 years old are at risk. Meningitis is severe most often in children and can lead to irreversible consequences, and in some cases to death. The disease affects the brain, therefore, with improper treatment, a person remains disabled. Most often, newborns suffer from severe consequences; in adults, meningitis is not so acute and is quickly treated.

Depending on the causes of meningitis, it can be bacterial, fungal or viral. The most complex form of the disease is bacterial meningitis. According to the type of inflammatory process, purulent and serous meningitis are distinguished. Serous meningitis is divided into two types: primary and secondary. The primary form of meningitis occurs due to low immunity and damage by various enteroviruses. The secondary form of the disease occurs after an infectious disease: measles, mumps, chickenpox and others.

Tuberculous meningitis is caused by the tubercle bacillus. Previously, this disease was not treated and the person died. Modern medicine is able to cure tuberculous meningitis, only 15-25% of all cases are fatal. Cryptococcal meningitis is a form of fungal meningitis. The process of inflammation of the brain and spinal cord is caused by the fungus Cryptococcus. Encephalitic meningitis - this type of disease begins when an encephalitis infection enters the body. It is transmitted through the bite of a tick or through the consumption of raw milk from an infected animal.

Causes of meningitis

The main cause of meningitis is viruses or bacteria that penetrate the soft membranes of the brain and spinal cord. In adults, the most common bacterial meningitis is caused by streptococcus and meningococcus bacteria. If they are in the nasal cavity or throat, the disease does not develop, but in case of infection of the blood and cerebrospinal fluid, soft tissues of the brain, they provoke meningitis.

Among the causes of meningitis are other types of bacteria. This is group B streptococcus, which often affects newborns infected during or after childbirth. The bacteria Listeria monocytogenes can cause meningitis in infants and the elderly. After suffering an infectious disease, a person can get meningitis, as his immunity is weakened and cannot resist bacteria. People with and are especially susceptible to this disease. Various head injuries can cause meningitis.

Ways of transmission of meningitis

A topical issue among patients is whether meningitis is transmitted by airborne droplets, like most infectious diseases. The answer to this question depends on the cause of the disease. So, if meningitis develops as a result of internal processes occurring in the brain, it is not contagious to others and is not transmitted. In the case when the disease is provoked by the penetration of a microorganism-causative agent into the membrane of the brain, meningitis is transmitted by airborne droplets.

It is characteristic that meningitis is transmitted from person to person not only in the way that is traditionally accepted when infected with infectious diseases. Infection with meningitis, in addition to airborne droplets, can be through food or through any contact with a carrier of the disease. In this case, the ways of contracting a disease such as meningitis are varied: sneezing, coughing, kissing, using common dishes, household items, staying in the same room with a sick person for a long time.

You can prevent the transmission of meningitis to a healthy person by strictly adhering to the rules for the prevention of infectious diseases and personal hygiene. This may include: wearing a medical mask in crowded places during outbreaks, avoiding prolonged exposure to public places. It also necessarily includes the complete cessation of contact with the carrier of the infection for the period of its treatment.

However, if infection nevertheless occurred, it is important to know that self-medication will not bring relief, but will only contribute to the development of complications. In order to quickly get rid of the disease of meningitis, at the first symptoms of the disease, it is necessary to consult a doctor. With qualified diagnosis and correct treatment, it will recede irrevocably.

Symptoms of meningitis

The symptoms of meningitis develop quickly and are easy to spot right away. The temperature rises sharply to 40 degrees, there is pain in the muscles, joints, there is general weakness and lethargy. Among the characteristic symptoms of meningitis in adults are the formation of a rash, runny nose and sore throat, as with a cold, pneumonia, disorders of the gastrointestinal tract, disruption of the salivary glands.

One of the most pronounced and common signs of meningitis is an acute headache that spreads to the entire area. The pain is growing and unbearable. Then nausea and severe vomiting appear. The patient does not tolerate sound and light stimuli.

Symptoms of meningitis are manifested in all patients to varying degrees. As a rule, they have a strong tension of the occipital muscles. A person feels severe pain when the head is tilted to the chest and the legs are extended at the knees. To relieve symptoms, the patient lies in a certain position. The person lies on his side, throwing his head back strongly, presses his hands to his chest, and bends his legs at the knees and presses him to his stomach.

Symptoms of meningitis in children are the same as in adults, but there may be additional signs of the disease. Among them are: diarrhea and regurgitation of food, drowsiness, apathy and weakness, constant crying and loss of appetite, swelling in the fontanel. Meningitis develops rapidly, at the first sign you can not hesitate and immediately go to the hospital. The incubation period of the disease is 2 to 10 days. The signs of meningitis are very similar to the usual or. The rate of development of the disease depends on the level of immunity of the child: the lower it is, the faster it affects the body.

One day after the onset of the first symptoms, the person's condition becomes critical. The patient may become delusional, there is apathy and drowsiness, irritability. The swelling of the tissues of the meninges begins, which makes it difficult for blood to flow to the organs and tissues, as in a stroke. With untimely help, a person falls into a coma and quickly dies.

Aseptic meningitis

Aseptic meningitis is an inflammation of the membranes of the brain and spinal cord, provoked in the human body, most often by a viral type pathogen. This disease can develop in patients of all age categories.

Usually, a disease such as aseptic meningitis is diagnosed and treated fairly quickly. However, for the timely diagnosis of the disease, it is necessary to know and understand the causes of the disease and the signs of its manifestation. This is what will be discussed in this article.

Reasons for the development of the disease

The main cause of aseptic meningitis in the human body is the causative microorganism. In this case, a virus (enterovirus) acts as the causative agent of the disease.

The penetration of the virus into the human body is carried out by the traditional, airborne or food way upon contact with the carrier. Then, penetrating through the tissues of the gastrointestinal tract or upper respiratory tract and palatine tonsils into the blood, enteroviruses spread throughout the body. With a weakened protective reaction of the body, pathogens transported by the circulatory system penetrate the membranes of the brain or spinal cord and provoke the development of the disease.

As mentioned above, enteroviruses are the cause of the disease in most cases. As for the causes that, in addition to viral microorganisms, lead to aseptic meningitis, then, by nature of origin, they can be divided into two categories - infectious and non-infectious.

As for non-infectious causes of the disease, these include previously suffered injuries or diseases, due to which aseptic meningitis may develop. These include: infectious diseases, inflammatory processes, tumors, concussions and injuries, exposure to chemotherapy drugs.

A feature of the aseptic type of the disease is, in particular, that the bacteria and viruses that provoked the disease are extremely difficult to detect by conventional methods. This presents some difficulty, but is not an unsolvable problem. Rather, on the contrary, it narrows the range of possible diseases for diagnosis.

Signs of aseptic meningitis

Symptoms of a disease such as aseptic meningitis appear quite clearly and are the first persistent signal that you should immediately consult a doctor. It is extremely important to remember that such a dangerous and fraught disease must be treated in the early stages. And for this you need to respond in a timely manner to the signs manifested by the disease.

First of all, you should pay attention to the general indicators of the state of health. Usually, they are subject to the following changes:

a significant and rapid increase in temperature;
state of fever, chills;
throbbing headache.

More specific signs, characteristic of other types of meningitis, in the aseptic form appear rather weakly and develop at a slow pace. But, nevertheless, their presence can be traced.

The main symptom of the development of any form of meningitis is meningeal syndrome. It manifests itself if the patient laid on his back cannot tilt his head to his chest without bending his knees. Moreover, the bending of the legs occurs uncontrollably.

The danger of this type of disease lies precisely in the fact that the specific signs of meningitis appear 4-5 days after the onset of the disease, which can lead to serious consequences. Therefore, in the presence of high fever, mild meningeal syndrome, headache and fever, one should not wait for further symptomatic confirmation.

Bacterial meningitis

Bacterial meningitis is an infectious disease, expressed in inflammation of the tissues of the spinal cord and brain, and provoked in the body by bacteria of the streptococcal group. The prevalence of this disease is quite insignificant, but the disease can easily be transmitted from person to person and cause epidemics among the population.

This type of disease has its own characteristics of occurrence (causes), symptoms, manifestations and methods of treatment, different from other forms of meningitis. This is exactly what will be discussed in this article.

In addition to the genetic predisposition of some peoples to develop meningitis, there are also reasons why this disease can affect the body of each patient. These include the state of health and age of the patient, as well as external pathogens.

Bacterial meningitis, like any other form of this disease, is provoked in the human body when the pathogen enters it. In the case of the form of the disease discussed in this article, the role of such a pathogen is played by harmful bacteria of the streptococcal group.

Bacterial meningitis is transmitted, like any infectious disease, by traditional, airborne or foodborne routes. This happens, as a rule, upon contact with the carrier of the infection through a handshake, kiss, sneezing or common dishes and household items, which by itself suggests the need for strict adherence to personal hygiene rules.

The penetration of streptococcus bacteria into the body does not end the process of infection and the development of the disease. Moreover, once transmission has taken place, there are two scenarios: meningitis and no meningitis.

The fact is that for the development of the disease, appropriate conditions are needed. In the case of meningitis, these are: a weakened immune system and a through reaction of the body. Only with such additional factors, harmful bacteria-causative agents of the disease penetrate the bloodstream and are transported to the brain. Therefore, in the presence of chronic diseases, bad habits, or a course of therapies that adversely affect immunity, the chance of getting meningitis increases significantly. This also explains the high susceptibility of younger patients to the disease.

Amoebic (encephalitic) meningitis

Amoebic or encephalitic meningitis is a dangerous inflammation of the meninges, which is provoked by small free-living amoebae, often enough for a long period of time, living in the human body.

The disease usually affects younger patients, putting children, adolescents, and adults under the age of 30 at risk. Encephalitic meningitis has different causes of development, symptoms and signs of manifestation, as well as methods of treatment and consequences, different from other forms of the disease. A detailed discussion of each of these factors will be provided in this article.

With a weakened protective reaction of the body, harmful microorganisms easily penetrate into the blood, and then, transported through the circulatory system, reach the central nervous system, namely, the membranes of the brain. After this, amoebic meningitis begins to develop and the first signs of the disease appear.

Purulent meningitis

Purulent meningitis is an infectious inflammation of the membranes of the brain, accompanied by the formation and release of purulent masses. This disease can occur in patients belonging to any age category. Often purulent meningitis occurs in children.

In order to understand how to deal with this disease, you need to know and be able to identify its symptoms. The described form of the disease has its own characteristics of manifestation, causes of development and methods of treatment. It is about them that will be discussed in this article.

The causes of a disease such as purulent meningitis are the penetration of pathogenic microorganisms into the membranes of the brain. The causative agents in this situation are usually harmful bacteria. These include streptococci, pneumococci, staphylococci, Pseudomonas aeruginosa and other pathogens. Most often, it is staphylococci that take part in the development of the disease, which is why this meningitis is often called staphylococcal.

As for how purulent meningitis is transmitted, there are several stages. The entry of the microorganism-causative agent of the disease into the human body, most often, occurs in the traditional airborne or food way.

Infection can occur through any contact with a carrier of the infection. Coughing or sneezing, shaking hands, or using shared utensils is enough to transmit harmful bacteria.

Then, penetrating through the tissues of the upper respiratory tract or stomach, harmful bacteria enter the bloodstream. And the causative agent of meningitis gets to the membranes of the brain by the hematogenous route, transported by the circulatory system. Then, after getting into the tissues of the meninges, the development of the disease begins.

A special characteristic of this disease is that its development, and in itself the penetration of bacteria into the blood, is possible only with a weakened immune system. Then the disease progresses quickly and without obstacles. This fact also explains the fact that the disease so often affects the child's body, whose immunity is not yet fully developed.

Tuberculous meningitis

Tuberculous meningitis is an inflammation of the meninges that occurs as a secondary disease after tuberculosis. This form of the disease is quite rare and, in most cases, in people with or recovering from tuberculosis.

The cause of such a disease as tuberculous meningitis is the spread of harmful pathogens from the focus of inflammation in the respiratory system to the brain. As mentioned above, most often, this type of disease is secondary, against the background of the development of tuberculosis. The main causative agent of both diseases are acid-fast bacteria, or, in other words, tuberculosis microbacteria.

Tuberculous meningitis is transmitted, like tuberculosis itself, by airborne droplets or food contact with a carrier of the infection. In the case of the spread of this disease, the carrier of dangerous microbacteria of tuberculosis can be people, animals and even birds.

It is also characteristic that when harmful microorganisms enter the body of a healthy person, whose immune system works well, tuberculosis bacteria are almost always destroyed. Therefore, as conditions necessary for the full development of the disease, weakened immunity, a low rate of the body's defense reaction are implied. It is a poorly developed immune system that is the reason that tuberculous meningitis manifests itself in children.

First of all, when it enters the respiratory organs, the disease is localized in them. Then, penetrating into the blood, tuberculosis microbacteria are transported by the circulatory system to the meninges. Just from this moment, the development of a secondary disease called tuberculous meningitis begins.

Viral meningitis

Viral meningitis is an inflammation of the membranes of the brain and spinal cord, which is provoked by the ingestion of a virus-causative agent of the disease into the human body. This disease can affect quite extensive, in terms of age categories, groups of patients, and is quite dangerous. Viral meningitis is most common in children.

This disease is one of the most curable forms of meningitis, but it also has its dangers. In order to clearly understand all the features and deterioration of this disease, you need to know the features of its manifestation, the causes of development, as well as the features of the course and treatment.

The main cause of this disease, as mentioned above, is a virus that causes a disease in the child's body. The entry of this provocateur into the child's body, as with any other infectious disease, occurs by airborne droplets or food through contact with the carrier of the infection.

A feature of the further development of the disease is that during the normal functioning of the immune system, this virus may not provoke serious disruptions, and even be destroyed. That is why viral meningitis so often affects children. The immunity of the child's body is not fully developed and cannot cope with the virus of this disease.

Due to such conditions, the causative agent of meningitis penetrates into the blood and, through the blood vessels, reaches the central nervous system. After reaching the brain, the virus contributes to the development of inflammation of its membranes.

Serous meningitis

Serous meningitis is an infectious disease characterized by the manifestation of a serous inflammatory process in the tissues of the membrane of the brain and spinal cord. This disease is most susceptible to children of preschool and school age, which is why the question of how serous meningitis manifests itself in children is relevant for all parents.

This disease is dangerous and extremely quickly transmitted from person to person. Therefore, every adult needs to know and understand what can provoke meningitis, what are the symptoms of its manifestation and the features of the course, as well as methods of treatment.

The cause of serous meningitis is the penetration into the human body of a microorganism-causative agent of the disease. Such microorganisms can be viruses, bacteria or fungi. However, due to the fact that in more than 80% of cases, it is viruses that provoke the disease, it is often called, especially when manifested in children, as serous viral meningitis.

Most often, this disease occurs due to enteroviruses entering the body. This also explains the fact that serous meningitis often occurs as a secondary disease as one of the viral diseases (measles, syphilis, AIDS, etc.).

It has been established that the entry of enterovirus into the body of a child can occur in two main ways: airborne and waterborne. Airborne transmission of infection from a carrier to a healthy person is the traditional route for this kind of disease. With any contact with a sick person (whether with a child or an adult), the disease virus enters the child's body: hugs, coughs, sneezes, kisses, common utensils, household items (toys).

As for the water route of transmission of the disease, in this case we are talking about a high content of harmful microorganisms in water bodies in summer. This explains the periodic epidemics of diseases in the warm season.

Getting into a child's body with still weak immunity, the virus of the disease freely penetrates through the skin and mucous membranes into the blood. Then, transported by the blood circulation, the pathogen reaches the lining of the brain. And after that, the development of serous meningitis begins.

infectious meningitis

Infectious meningitis is a dangerous inflammatory disease that affects the tissues of the spinal cord and brain. As a primary infectious disease, meningitis is provoked by various microorganisms, which explains the diversity in the course of the disease, the expression of symptoms and treatment.

This type of disease can be easily transmitted from person to person and can affect patients of different ages and both sexes equally. Infectious meningitis has its own characteristics of occurrence (causes), symptoms, manifestations and methods of treatment, different from other forms of meningitis. This is exactly what will be discussed in this article.

The main reason why a disease such as infectious meningitis develops in the human body is the penetration of a pathogen into it. Moreover, the role of such a pathogen, in this case, can be played by harmful viruses, bacteria or even a fungus.

Infectious meningitis, like any disease of this type, is transmitted by traditional, airborne or foodborne routes. This happens, as a rule, upon contact with the carrier of the infection through a handshake, kiss, sneezing or common dishes and household items, which by itself suggests the need for strict adherence to personal hygiene rules. In this regard, the way the infection of a disease called meningitis is transmitted to another person is not much different from other diseases.

The peculiarity of the development of the disease is that the infection process is not limited to the fact of penetration of pathogenic microorganisms into the body. Moreover, with the normal functioning of the body's defense system, meningitis may not occur.

Cryptococcal meningitis

Cryptococcal meningitis (cryptococcosis) is an inflammatory disease that affects the lining of the brain, which has a fungal nature of development. This disease has no age limits in the defeat of patients, therefore it is equally dangerous for all age groups of patients.

For timely diagnosis and treatment, as well as in order to prevent the development of the disease, it is worth knowing and understanding what are the causes, symptoms and features of the course of the disease. A description of all the described parameters can be found in this article.

As mentioned above, cryptococcal meningitis has a fungal nature of development. And, therefore, as with other infectious diseases, the cause of this disease in the patient's body is the pathogen microorganism. In this case, fungus.

The penetration of the microorganism-causative agent into the tissue of the brain membrane occurs in the standard way for this disease. The fungus enters the surface of the palatine tonsils and upper respiratory tract by airborne droplets or food. Then, under the condition of reduced work of the body's defense systems, the pathogen enters the bloodstream and, thanks to the well-functioning work of the circulatory system, moves to the brain tissue.

A distinctive feature of the occurrence of cryptococcosis is that, as an independent disease, it is extremely rare. All diseases of the nervous system of the body that have a fungal nature of development usually develop in people who have already had diseases that have weakened their immunity, including those with hemoblastoses, diabetes mellitus, AIDS, and malignant tumors. A disease such as cryptococcosis is a fairly common case after long-term therapies using antibacterial, corticosteroid, immunosuppressive drugs.

Symptoms of the development of the disease

Symptoms of a disease such as cryptococcosis are extremely difficult to identify. This is due to the parallel or subsequent development of meningitis after another disease. Therefore, in order to track an additionally developing disease, it is periodically recommended to conduct diagnostics for inflammation of the meninges during the course of the underlying disease.

Symptoms of a disease such as cryptococcal meningitis can be divided into two categories: general infectious and specific meningeal. At the same time, signs common to all infectious diseases can easily be lost against the background of the underlying ailment, which cannot be said about specific ones.

General infectious signs of this type of meningitis are usually chronic. These include:

an increase in temperature by several marks (up to 37.8-38? C);
fever state.

Against the background of a constantly elevated, albeit slightly, body temperature, diseases of the respiratory tract, ears, and oral cavity can develop. Therefore, a prolonged change in body temperature should serve as a signal that meningitis is developing in the body. In combination with the specific signs of the disease, you can get a good reason for a preliminary diagnosis.

As for the specific symptoms of the disease, they include the usual signs of brain damage. Their list includes:

intense throbbing headache;
dizziness;
nausea and vomiting not associated with meals;
photophobia and sound phobia;
soreness of the neck muscles;

The main symptom indicating the development of meningitis in the patient's body is meningeal syndrome. Its manifestation lies in the fact that the patient's legs will involuntarily bend at the knees, if he, when taking a horizontal position, tilt his head to the chest.

Meningitis in babies

In newborns, this disease is quite rare. The incidence of meningitis in infants ranges from 0.02% to 0.2%, depending on the weight of the newborn and his state of health.

It is extremely important for the parents of the baby to know the causes of the disease, to be able to recognize its symptoms and understand the features of treatment, in order to know how to behave when meningitis is manifested in the baby. All of these issues will be discussed in this article.

Symptoms of meningitis in newborns

There is a set of signs of the development of the disease that can occur in both infants and adult patients. However, due to the fact that a newborn child cannot show or tell that he is in pain, in this case, it is worth paying attention to a larger range of factors. So, the symptoms of a disease such as meningitis in infants will manifest themselves as follows:

a significant increase in temperature;
state of fever, chills;
convulsions and twitches;
increase and pulsation of the fontanel;
diarrhea;
nausea and profuse vomiting;
decreased or complete lack of appetite;
a state of general weakness of the body.

Signs of meningitis in infants are also reflected in the behavior of the child. A newborn baby, due to a severe headache, due to inflammation, is very excited, restless, the state of irritation is replaced by drowsiness. An experienced parent will be able to notice that the complex of the symptoms of the disease listed above can be inherent in any ailment of an infectious nature. That is why for the accurate diagnosis of the disease, there are specific signs of the disease.

meningeal syndrome

Meningeal syndrome is the main specific symptom that determines the presence of the inflammatory disease meningitis in the meninges. The peculiarity of its manifestation is that if you try to tilt the patient's head to the chest while he is in a horizontal position, his legs will bend uncontrollably at the knees. This test is good for both children and adults.

Symptoms of Lesage

Due to the fact that in newborns the symptoms of a disease such as meningitis are very mild, an examination of the fontanel (unfused skull bones) is performed to confirm suspicions. When meningitis occurs, this area becomes inflamed and pulsates.

Lesage's symptom is also called the pose of the pointing dog. Its essence lies in the fact that when the baby is held by the armpit area, he involuntarily pulls his legs to his stomach and throws his head back.

Causes

Infection of a newborn child usually occurs in a way that has become traditional for this type of disease. We are talking about the transmission of pathogens by airborne droplets from the carrier of the infection, which can be adults or the same small children.

Treatment of meningitis

Diagnosing meningitis is fairly easy, but the diagnosis must be confirmed by a doctor. Since the disease develops rapidly, you can not hesitate even a minute. Treatment of meningitis is carried out only under the supervision of doctors in the hospital, it cannot be treated at home. To confirm the disease, as well as to determine the pathogen, the patient undergoes a spinal puncture. With timely access to a doctor, meningitis is well treated and does not give complications. The methods of treatment of meningitis include several drugs and vaccines to eliminate the pathogen:

The main treatment for meningitis is antibiotic therapy. At the first symptoms of the disease, broad-spectrum antibiotics from the group of penicillins, cephalosporins and macrolides are immediately used. Broad-spectrum drugs are prescribed to immediately eliminate the pathogen. The results of the analysis of cerebrospinal fluid will not be ready immediately, and it is almost impossible to determine the causative agent of meningitis in a blood test. Antibiotics are administered to the patient intravenously, and in severe forms of the disease, drugs can be injected into the spinal canal. The duration of the course of antibiotic treatment is determined by the doctor, but the patient will receive medication for at least a week after his normal temperature stabilizes.
Diuretics may be used in the treatment of meningitis. When using diuretics, fluid is simultaneously injected into the patient's body. Diuretics contribute to a strong leaching of calcium from the body, so the patient is prescribed a vitamin complex.
With meningitis, detoxification therapy is used. It is necessary to reduce the symptoms of intoxication. The patient is injected intravenously with saline, glucose solution and other drugs.

The duration of treatment for meningitis varies and depends on the degree of development of the disease, the patient's condition. In children, this disease can give various complications, in adults it is quickly treated without consequences. After completion of therapy in the hospital, it is necessary to continue treatment at home, to strengthen the immune system. The patient can restore health within one year, so it is not always possible to return to work or school.

Prevention of meningitis

Preventive measures for meningitis primarily include mandatory vaccination. Vaccination will help prevent the development of many diseases that lead to meningitis. Vaccination should be given to children at an early age. Bacterial and viral meningitis vaccines include vaccinations against Haemophilus influenzae type B, against infections that cause pneumonia and other diseases. Vaccination should be carried out for a child aged 2 months to 5 years, as well as for children over 5 years old who suffer from serious illnesses. Before the invention of the vaccine, bacteria were thought to be the most common cause of bacterial meningitis, but vaccines have been able to eradicate it.

Meningococcal vaccination can protect against the main bacteria that cause meningitis. It must be done to a child aged 11-12 years. This type of vaccination should be given to students living in a hostel, recruit soldiers, patients with immunodeficiency, as well as tourists and workers traveling to countries where a meningitis epidemic can break out, for example, countries in Africa. It is necessary to carry out mandatory vaccination against other infectious diseases:, and others.

Other measures to prevent meningitis include maintaining personal hygiene and cleanliness:

exclusion of contact with people with meningitis;
after contact with an infected person, it is necessary to receive a preventive course of medication;
wear a disposable medical mask during epidemics of influenza and other infectious diseases;
wash hands before eating, after transport and public places, use antibacterial agents;
do not drink raw water, process vegetables and fruits with boiling water, boil milk;
avoid swimming in stagnant water;
strengthen the immunity of the child from an early age.

Consequences of the disease

Meningitis is dangerous because its untimely or incorrect treatment can lead to serious complications that will remind of themselves for many years. Moreover, it does not matter at what age the disease was transferred. The consequences after meningitis are manifested in both adults and children.

In older patients, the list describing the complications after meningitis includes: regular headaches, hearing loss, significant visual impairment, epileptic seizures, and many other deteriorations in the functioning of the body that can haunt the patient from several months to several years.

As for the consequences of meningitis for children, then, in this case, the situation is even more dangerous. If the disease occurs in the first years of a child's life, the probability of death is very high. If the disease was defeated, then it can cause mental retardation, disruption of the basic functions of the brain and the entire nervous system of the child's body.

Moreover, the threat of a fatal outcome of the disease exists not only for children. As an answer to the question of whether it is possible to die from meningitis, let's talk about one of its most serious complications. We are talking about .

This complication is more common in younger patients, but not infrequently in adults. With the onset of this complication of an infectious disease, meningitis, the patient's blood pressure and heart rate begin to change dramatically, shortness of breath increases and pulmonary edema develops. The result of this process is paralysis of the respiratory tract. What are the consequences after such a complication of meningitis, it is not difficult to guess - the death of the patient.

Another complication called toxic shock leads to the same consequences. Without going to the doctors at the first manifestations of the disease, it is impossible to cope with the complications of the disease.

If we talk about the general list, then the consequences of meningitis affect the health of men, women and children. This indicates the urgent need for correct treatment and proper rehabilitation after illness.

The most common consequences of meningitis include: disruption of the nervous system, mental disorders, dropsy (excessive accumulation of fluid in the brain), hormonal dysfunctions and others. This disease, even in the process of treatment, can have a negative effect on the body. With the introduction of drugs, blood pressure is significantly reduced, the work of the urinary system worsens, calcium is washed out of the bones.

It is important to know and always remember that timely diagnosis and correct treatment can save not only the health of the patient, but also his life. Therefore, in order to avoid consequences that pose a real threat to life, at the first symptoms of the disease, you need to consult a doctor.

Purulent meningitis in newborns - inflammation of the brain
membranes, a serious disease that occupies one of the first places among infectious
CNS diseases in young children. The incidence of purulent meningitis
is 1-5 per 10 thousand newborns.

It can result in death or disabling
complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis,
epilepsy, delayed psychomotor development up to oligophrenia). Exodus
depends on timely intensive treatment. Etiology and pathogenesis.

According to the etiology, meningitis is divided into viral, bacterial and
fungal. The route of infection is hematogenous. Child infection
can occur in utero, including during childbirth or postnatally.
Sources of infection are the genitourinary tract of the mother, infection is also
can occur from a patient or from a carrier of pathogenic microflora. development
meningitis is usually preceded by hematogenous spread of infection.
Microorganisms overcome the blood-brain barrier and enter the CNS.
Predisposing factors include maternal urinary tract infections,
chorioamnionitis, long anhydrous period (over 2 hours), intrauterine
infection, prematurity, intrauterine hypotrophy of the fetus and its
morphofunctional immaturity, fetal and newborn asphyxia, intracranial
birth trauma and related therapeutic measures, malformations
CNS and other situations where there is a decrease in immunological factors
protection. The penetration of a bacterial infection into the bloodstream of a child is facilitated by
inflammatory changes in the nasal and pharyngeal mucosa in acute respiratory
viral infection, which, according to our observations, often accompanies the onset
purulent meningitis.

The causative agents of meningitis are now often
Streptococcus agalactiae (group B beta-hemolytic streptococcus) and
Escherichia coli. Meningococcal etiology of purulent meningitis in newborns
is now rarely observed, which, apparently, is due to the passage
through the mother's placenta to the fetus immunoglobulin G containing antibodies to
meningococcus. Intrauterine meningitis usually presents clinically in
the first 48-72 hours after birth, postnatal meningitis appears later.
According to our data, such children were admitted to the clinic on the 20th-22nd day of life,
when there is a decrease in the content of immunoglobulin G obtained from the mother,
in the blood serum of the newborn. By this time, maternal immunoglobulin G
catabolized and its level in the blood decreases by 2 times.

Postnatal meningitis can also develop in departments
resuscitation and intensive care and in the departments of nursing premature babies.
Their main pathogens are Klebsiella spp., Staphylococcus aureus,
P.aeroginosae and fungi of the genus Candida. As our observations showed, in the anamnesis
mothers noted such risk factors as the threat of abortion,
infection of the urinary system, the presence of chronic foci of infection in pregnant women
(tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as long-term
anhydrous interval in childbirth (from 7 to 28 hours).

Despite the diversity of causative agents of purulent meningitis in
newborns, morphological changes in the central nervous system are similar in them. They are localized in
mainly in soft and arachnoid shells. Exudate is removed by
phagocytosis by macrophages of fibrin and necrotic cells. For some it
undergoes organization, which is accompanied by the development of adhesions.
Violation of the patency of the cerebrospinal fluid can lead to the development of occlusive
hydrocephalus. Reparation can be delayed for 2-4 weeks or more.

Clinic and diagnostics

There are difficulties in diagnosing purulent meningitis both at home,
and when the child is admitted to the hospital, since clear clinical manifestations
develop later, and at first there are nonspecific symptoms similar to
many infectious and inflammatory diseases (pallor, marbling,
skin cyanosis, conjugative jaundice, hyperesthesia, vomiting). Some children
there is an increase in temperature to subfebrile figures. Symptoms of the disease
develop gradually. The child's condition is progressively deteriorating. Temperature
rises to 38.5-39оС. On examination, the skin is pale, sometimes with a grayish
shade, acrocyanosis, marbling are often noted, sometimes children have pronounced
conjugative jaundice. Respiratory system disorders -
decrease in respiratory rate, apnea attacks, and from the side of the cardiovascular
system is characterized by bradycardia. Patients also have hepato- and
splenomegaly.

In neurological status in some newborns
there are signs of CNS depression: lethargy, drowsiness, weakness, decreased
physiological reflexes, muscle hypotension. Others have symptoms
CNS excitation: restlessness, hyperesthesia, painful and
piercing scream, tremor of the chin and limbs, foot clonus. Violations with
cranial nerve sides may present as nystagmus, floating
movements of the eyeballs, strabismus, a symptom of the "setting sun". Some
children experience regurgitation and repeated vomiting, sluggish suckling, or refusal to breastfeed
and nipples. A sick child is not gaining weight well. At a later date
head tilting back, meningeal symptoms (tension
and bulging of the large fontanel, stiffness of the muscles of the back of the neck).
Characteristic posture of the child on its side with the head thrown back, legs bent and
pressed to the stomach. Meningeal symptoms typical of older children (Kernig,
Brudzinsky), are uncharacteristic for newborns. Sometimes there is a positive
Lessage's symptom: the child is lifted up, taking the armpits, and in this
while his legs are in a flexion position. Polymorphs may be seen
convulsions, paresis of cranial nerves, changes in muscle tone. The reason for the development
seizures are hypoxia, microcirculatory disorders, cerebral edema, and sometimes
hemorrhagic manifestations. In some cases there are
rapidly progressive increase in head circumference, divergence of cranial sutures after
account of intracranial hypertension.

Analysis of case histories of newborns with purulent meningitis,
were in our clinic, revealed that they all arrived at the age of 7 to
28 days of life (average age - 23 days). When referred to a hospital, only 2
purulent meningitis was suspected in children; in the rest, the guiding diagnosis was
ARVI, enterocolitis, conjugative jaundice, intrauterine infection, infection
urinary system, osteomyelitis. At admission, most newborns do not
there were clear and characteristic signs of meningitis. However, anamnestic
data and serious condition allowed us to consider that the disease began earlier,
which was confirmed by studies of the cerebrospinal fluid. Upon admission to
Most of the children had an increase in temperature up to 38-39.6°C. Expressed
catarrhal phenomena, as a rule, were not. Some children in clinical
there were manifestations of a local purulent infection (purulent conjunctivitis,
omphalitis, urinary tract infection).

In the blood test, most children showed inflammatory
changes in the form of an increase in the number of leukocytes (13-34.5x109 / l) with a significant
an increase in the number of stab neutrophils up to the appearance of young forms,
as well as an increase in ESR up to 50 mm / h.

Changes in urine tests (leukocyturia) were observed in three
children with a combination of purulent meningitis with pyelonephritis.

To confirm the diagnosis, a lumbar puncture should be
carry out at the slightest suspicion of meningitis, in the early stages, without waiting
development of his expanded clinic. In cases where, for whatever reason,
succeed in performing a lumbar puncture, one should be guided by the clinical
picture of the disease. Lumbar puncture for purulent meningitis in
in newborns, cerebrospinal fluid often leaks under pressure, is cloudy,
sometimes, with a large cytosis, yellow color, thick. Contraindication to
lumbar puncture is performed by shock and DIC.

In our observations, almost all admitted children
The diagnosis was made on the first day of hospital stay. Indication for
urgent lumbar puncture were the presence of febrile temperature
(above 38 ° C), symptoms of infectious toxicosis without a visible focus of bacterial
infections, less often - hyperesthesia. In the liquor there was an increase in the content
leukocytes with a predominance of the neutrophil link (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid
rises later than neutrophilic pleocytosis increases. Protein content
increases from the onset of the disease and may serve as an indicator of the duration
pathological process. In our studies, the protein concentration fluctuated
from 0.33 0/00 to 9 0/00. Increased protein content in the cerebrospinal fluid,
obtained at the first puncture, it was found in 10 patients that
indicated a certain duration of the disease. For purulent
meningitis is characterized by a low level of glucose in the cerebrospinal fluid.

In order to identify the pathogen and determine its
sensitivity to antibiotics microbiological examination is carried out
liquor. In our observations, clinical and laboratory data indicated
purulent nature of meningitis, while the sowing of cerebrospinal fluid and bacterioscopy of a smear in
In most cases, the pathogen was not identified. Two patients were found
group B beta-hemolytic streptococcus, one had a hemophilic
coli, and another has pneumococcus.

Serous inflammation is characteristic of viral meningitis
meninges with an increase in the content of lymphocytes in the cerebrospinal fluid. Serous
meningitis is characterized by a milder course.

Instrumental methods include ultrasonic
examination of the brain (neurosonography) and computed tomography,
which are carried out according to indications.

Neurosonography allows diagnosing ventriculitis,
expansion of the ventricular system, the development of a brain abscess, and to identify
severe concomitant intracranial hemorrhages, ischemic infarcts, malformations
development.

Computed tomography is indicated to rule out abscess
brain, subdural effusion, as well as to identify areas of thrombosis, infarcts
and hemorrhages in brain structures.

Complications

The most common early complications are edema and
swelling of the brain and convulsive syndrome.

Clinically, cerebral edema is manifested by increasing intracranial
hypertension. During this period, the posture of the newborn is characteristic with
head thrown back, monotonous, sometimes piercing,
scream, sometimes turning into a groan. Possible bulging of a large fontanel, its
pulsation, divergence of cranial sutures. Cerebral edema can be clinically manifested
dysfunction of the oculomotor, facial, trigeminal and sublingual
nerves. Coma is clinically manifested by depression of all types of cerebral
activity: adynamia, areflexia and diffuse muscular hypotension. Further
there is a disappearance of the reaction of the pupils to light, apnea attacks become more frequent,
bradycardia develops.

With purulent meningitis, convulsive syndrome often develops.
Initially, convulsions are clonic in nature, and as the edema progresses
brain are transformed into tonic.

A very dangerous complication of meningitis is
bacterial (septic) shock. Its development is associated with penetration into
bloodstream of a large number of bacterial endotoxins. Clinically
septic shock is manifested by sudden cyanosis of the extremities, catastrophic
decrease in blood pressure, tachycardia, shortness of breath, groaning weak cry,
loss of consciousness, often in combination with disseminated syndrome
intravascular coagulation. Among the newborns observed by us, two children
died. One girl was admitted on the 11th day of life and died in the first 6 hours
hospital stay from infectious-toxic shock, complicated
disseminated intravascular coagulation. Second girl aged
17 days died on the 2nd day after admission. She had intrauterine
generalized cytomegalovirus infection and purulent meningitis developed.
Severe consequences of purulent meningitis can be hydrocephalus, blindness,
deafness, spastic paresis and paralysis, oligophrenia, epilepsy.

Differential Diagnosis

Similar to purulent meningitis neurological symptoms
can be observed in the presence of intracranial hemorrhage in a newborn. At
such children also have motor restlessness, chin tremor and
limbs, nystagmus, strabismus, a symptom of the "setting sun". For exclusion
purulent meningitis requires a lumbar puncture. For
intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large
the number of altered erythrocytes, as well as an increased concentration of total protein
in the cerebrospinal fluid from the first days of the disease due to the penetration of plasma proteins and
lysis of erythrocytes.

Often purulent meningitis occurs with vomiting, so it is necessary
conduct differential diagnosis with pyloric stenosis, in which
there is vomiting "fountain" without fever and inflammatory
changes in the blood test. Abdominal examination often shows a positive
hourglass symptom. The main methods for diagnosing pyloric stenosis are
esophagogastroduodenoscopy and ultrasound.

Symptoms of excitation of the central nervous system
(anxiety, tremor of the limbs and chin, hyperesthesia), similar to purulent
meningitis, can be observed with influenza and SARS. In this case, there is
meningism is a condition characterized by the presence of clinical and cerebral
symptoms without inflammatory changes in the cerebrospinal fluid. Meningism is not caused
inflammation of the meninges, and their toxic irritation and increased
intracranial pressure. On lumbar puncture, the fluid is clear and
colorless, flows out under high pressure, often in a jet, but the content
cells, protein, and glucose are normal. Meningismus usually presents with acute
period of illness and often precedes inflammation of the meninges, which
can develop within a few hours after its detection. If a
meningeal symptoms with influenza and SARS do not disappear, or, moreover, increase,
repeated diagnostic spinal punctures are necessary.

Suppurative meningitis may occur in a child with sepsis, which
significantly aggravates the clinical picture of the disease.

Treatment

Newborns with purulent meningitis need a comprehensive
treatment, including antibiotic, infusion therapy, substitution
intravenous immunoglobulin therapy. If necessary
hormonal, anticonvulsant, dehydration therapy is carried out. So
children need the most gentle mode. In the acute period they are not recommended.
breastfeed. They receive expressed breast milk or, in the absence of
his mother, formula from a bottle. When the sucking reflex is suppressed
feeding the child through a tube is applied.

Etiotropic antibiotic therapy is the main
method of treatment of newborns with purulent meningitis. It is carried out taking into account
isolated from the cerebrospinal fluid of the pathogen and its sensitivity to
antibiotics. If the pathogen was not found, the effectiveness of the antibacterial
therapy is assessed by clinical data and the results of a repeated study
liquor no later than 48-72 hours from the start of treatment. If during this time not
there is a clear clinical and laboratory improvement, a change is made
antibacterial treatment. In neonates with purulent meningitis, antibiotics
must be administered intravenously three or four times at the maximum allowable doses
through a subclavian catheter.

Use antibiotics that penetrate through
blood-brain barrier and have a wide spectrum of antimicrobial activity.
A combined course of antibiotic therapy usually includes
third generation cephalosporins (ceftazidime, ceftriaxone) and aminoglycoside
(amikacin, netilmicin, gentamicin). To all children treated by us
antibiotic therapy was prescribed immediately upon admission to the hospital and
included a cephalosporin. After receiving the result of the lumbar puncture in the scheme
combined antibiotic therapy, a second antibiotic was added
aminoglycoside series. If a second course of antibiotics is needed when not
it was possible to achieve an improvement in the patient's condition and normalization of indicators
cytosis in the CSF, the children received a second course of antibiotic therapy
meropenem, vancomycin.

The question of hormonal therapy was decided
individually, taking into account the severity of the condition. With severe purulent meningitis
hormone therapy in the acute period of the disease led to an earlier
the disappearance of fever and intoxication, the improvement of the condition of the newborn.

For the treatment of hypertension-hydrocephalic syndrome
dehydration was carried out using furosemide. Subsequently, after
elimination of symptoms of infectious toxicosis, in the presence of intracranial
hypertension was prescribed acetazolamide according to the scheme.

As our observations have shown, a good effect is obtained by including in
a treatment regimen to increase the body's defenses of immunoglobulin for
intravenous administration, which is especially effective in the early stages of the disease.
Immediately after the diagnosis was established, all patients were started on intravenous
administration of immunoglobulin. It was administered 2 to 5 times with obligatory laboratory
control (determination of immunoglobulins G, M and A) before and after administration. More
frequent administration was required by children who had a slow positive dynamics
clinical and laboratory symptoms.

Viferon in suppositories containing recombinant human
leukocyte interferon alfa-2b, connected later, after improvement
clinical and laboratory indicators. It was administered at a dose of 150,000 IU 2 times a day,
the duration of the course was 10 days.

Simultaneously with the start of antibiotic therapy in children,
started intensive infusion therapy through the subclavian catheter, including
transfusion of solutions of glucose, rheopolyglucin, vitamins (C, B6,
cocarboxylase), furosemide, antihistamines for the purpose of detoxification,
improvement of microcirculation, correction of metabolic disorders.

Diazepam was used to relieve convulsive syndrome. FROM
phenobarbital was prescribed for maintenance anticonvulsant therapy.
They also used drugs that improve cerebral circulation (Vinpocetine,
cinnarizine, pentoxifylline).

The average stay of patients in the clinic was 26 days (from 14
up to 48 days).

Forecast and long-term consequences

Purulent meningitis in newborns is a serious disease,
mortality from which remains high.

As our studies have shown, complex intensive
therapy of purulent meningitis in newborns, started at an early stage
diseases, gives good results. Supervision for 1-3 years for children,
who had purulent meningitis in the neonatal period, showed that the majority
of which, with early detection of the disease and adequate therapy, psychomotor
development is age appropriate. However, two children developed progressive
hydrocephalus, four had violations of muscle tone and
subcompensated hypertensive-hydrocephalic syndrome.

Currently, less than 15-20% of newborns with sepsis develop meningitis. Mortality from meningitis, according to the literature, ranges from 20-25 to 33-48%.

There is no clear specificity of the microbiological picture; the flora transmitted to the newborn from the mother is characteristic.

Causes of meningitis in newborns

Ways of spread of infection:

most often hematogenous (as a result of bacteremia);
along the length - with infected defects of the soft tissues of the head;
along the perineural lymphatic pathways, often coming from the nasopharynx.

The inflammatory process in meningitis is most often localized in the soft and arachnoid membranes (leptomeningitis), less often in the dura mater (pachymeningitis). However, in newborns, all membranes of the brain are more affected. Through the perivascular spaces, the infection can spread to the substance of the brain, causing encephalitis, and to the ependyma of the ventricles (ventriculitis). Purulent meningitis is rare. The absence of an inflammatory response may be the result of a rapidly progressive infection, with an interval of only a few hours from the onset of clinical manifestations to death, or may reflect an inadequate response of the body to infection.

Consequences of meningitis in newborns

swelling of the brain;
the development of vasculitis leads to the prolongation of inflammation, the development of phlebitis, which may be accompanied by thrombosis and complete occlusion of blood vessels (often veins); occlusion of several veins can lead to the development of a heart attack;
hemorrhages in the parenchyma of the brain;
hydrocephalus as a result of closing the aqueduct or opening of the IV ventricle with purulent exudate or through inflammatory disorders of CSF resorption through the arachnoid;
subdural effusion, cortical atrophy, encephalomalacia, porencephaly, brain abscess, cysts.

Symptoms and signs of meningitis in newborns

early manifestations are nonspecific:
- deterioration in general well-being;
- fluctuations in body temperature;
- gray-pale skin;
- marbling of the skin;
- poor microcirculation;
physical inactivity, increased tactile sensitivity, hypotension;
unwillingness to drink, vomiting;
cyanosis, tachycardia, shortness of breath, episodes of apnea;
tachycardia, bradycardia;
late manifestations:
- piercing cry;
- tense fontanel;
- opisthotonus;
- convulsions.

Initial signs are common to all neonatal infections, they are non-specific and depend on birth weight and maturity. In most cases, signs are not characteristic of CNS disease (episodes of apnea, eating disorders, jaundice, pallor, shock, hypoglycemia, metabolic acidosis). Obvious signs of meningitis are observed only in 30% of cases. Neurological symptoms may include both lethargy and irritability, convulsions, and bulging of the large fontanel. Meningitis as a manifestation of RNS usually develops in the first 24-48 hours of life.

Diagnosis of meningitis in newborns

Lumbar puncture for CSF analysis. Complete blood count, CRV, blood glucose, electrolytes; coagulogram, blood culture.

Diagnosis is based on microbiological methods (isolation of a culture of microorganisms from CSF and blood cultures). CSF cultures are positive in 70-85% of patients who have not previously received antibiotic therapy.

Negative cultures may be obtained during antibiotic therapy, brain abscess, infection caused by M. hominis, U. urealyticum, Bacteroidesfragilis, enteroviruses, or herpes simplex virus. Infectious meningitis in newborns is characterized by an increase in the protein content in the CSF and a decrease in the concentration of glucose. The number of leukocytes in the CSF is usually increased due to neutrophils (more than 70-90%).

Despite the large variation in CSF cellular composition, the CSF leukocyte content of >21 cells per 1 mm3 for culture-proven meningitis is generally accepted (sensitivity - 79%, specificity - 81%). Cytological and biochemical methods (changes in the cellular and biochemical composition of CSF) are not always specific.

CSF glucose should be at least 55-105% of the blood glucose level in premature babies, and 44-128% in full-term babies. Protein concentration may be low (<0,3 г/л) или очень высокой (>10 g/l).

There is no unequivocal opinion on the need to study CSF in patients with RNS. The American Academy of Pediatrics recommends a spinal tap for newborns in the following situations:

positive blood culture;
clinical or laboratory evidence strongly suggests bacterial sepsis;
deterioration during antimicrobial treatment.

Lumbar puncture, if necessary, may be delayed until the condition stabilizes, although in this case there is a risk of delay in diagnosis and possibly inappropriate use of antibiotics. If a neonate with suspected sepsis or meningitis has abnormal CSF values, but blood and CSF cultures are negative, repeat lumbar puncture should be performed to rule out anaerobic, mycoplasmal, or fungal infections; it is also necessary to study the CSF for herpes, cytomegalovirus, toxoplasmosis. Late analysis (delay more than 2 hours) can significantly reduce the number of leukocytes and the concentration of glucose in the CSF. The optimal delivery time of the material to the laboratory should not exceed 30 minutes.

Meningitis with normal values. Up to 30% of newborns with GBS meningitis may have normal CSF values. In addition, even microbiologically confirmed meningitis does not always lead to changes in the cellular composition of the CSF. Sometimes, in addition to increased CSF pressure, another pathology in the CSF may not be detected, or the indicators may be "borderline". In doubtful cases, for example, with “borderline” CSF values (leukocytes > 20 in 1 mm3 or protein > 1.0 g / l), in the presence of clinical symptoms, it is necessary to examine newborns for the presence of specific infections (syphilis, rubella, cytomegalovirus, herpes, AIDS virus).

Microscopy with Gram stain. Organisms in Gram-stained CSF smears are found in 83% of neonates with GBS meningitis and in 78% of neonates with Gram-negative meningitis.

The probability of visualizing bacteria on a Gram stain correlates with the concentration of bacteria in the CSF. Isolation of CSF culture is critical to the diagnosis, regardless of other findings. A complete study of the CSF is all the more necessary, since the pathogen isolated from the blood will not always correspond to the CSF culture.

Ventricular puncture should be considered for meningitis that does not respond clinically or microbiologically to antibiotic therapy due to ventriculitis, especially if there is obstruction between the cerebral ventricles and between the ventricles and the spinal canal.

Treatment of meningitis in newborns

Antibiotics, anticonvulsants, possibly sedatives.

IVL at violations of regulation of breath. Patient monitoring. Careful control of the level of consciousness. Seizures? A bulging, tense fontanel?

For the treatment of meningitis, the same antibiotics are chosen that are used for the treatment of RNS, since these diseases are caused by similar pathogens. Empiric therapy for meningitis usually involves a combination of ampicillin (or amoxicillin) at antimeningitis doses and an aminoglycoside, or a third-generation cephalosporin or a fourth-generation cephalosporin in combination with an aminoglycoside; for infection caused by methicillin-resistant Staphylococcus aureus, vancomycin is used; for candidal meningitis, amphotericin B. If herpes is suspected, initial antibiotic therapy should be supplemented with acyclovir.

After isolation of the pathogen from the CSF and / or blood, antibiotic therapy is adjusted in accordance with the sensitivity of the microflora.

The concentration of aminoglycosides may not reach a sufficient level in the CSF to suppress the flora, so it seems understandable to suggest that some experts prefer third-generation cephalosporins. However, third-generation cephalosporins should not be used as monotherapy for the empiric treatment of meningitis due to resistance of L. monocytogenes and enterococci to all cephalosporins. Doses of antibacterial drugs must be selected, taking into account their permeability through the blood-brain barrier (you must read the instructions for the drug). Currently, most investigators do not recommend intrathecal or intraventricular antibiotics for neonatal meningitis.

48-72 hours after the start of antibiotic therapy, it is necessary to re-examine the CSF to monitor the effectiveness of treatment. IV antibiotic therapy should be continued after CSF sterilization for at least 2 weeks. with GBS or Listeria, or 3 weeks if the causative agent is gram-negative bacteria. Consider longer duration if focal neurologic signs persist for more than 2 weeks, if CSF sterilization takes more than 72 hours, or if obstructive ventriculitis, infarction, encephalomalacia, or abscess is present. In such circumstances, the duration of therapy can be determined using repeated lumbar punctures. With pathological indicators of CSF (glucose concentration<1,38 ммоль/л, содержание белка >3 g/l or the presence of polymorphonuclear cells >50%), with no other explanation for this, continued antimicrobial therapy is assumed to prevent relapse. After the end of the course of antibiotic therapy, a repeated examination of the brain by various methods of neuroimaging is indicated. Currently, MRI is the best method for assessing the state of the brain in a newborn.

Care

Carefully, regularly monitor vital signs.

The exact balance of the injected and excreted fluid is important, since there is a danger of cerebral edema.

Prognosis of meningitis in newborns

Among children with GBS meningitis, the mortality rate is about 25%. From 25 to 30% of surviving children have serious neurological complications, such as spastic quadriplegia, severe mental retardation, hemiparesis, deafness, blindness. From 15 to 20% - mild and moderate neurological complications. Newborns with meningitis caused by gram-negative bacteria die in 20-30% of cases, in survivors, neurological complications occur in 35-50% of cases. They include hydrocephalus (30%), epilepsy (30%), developmental delay (30%), cerebral palsy (25%) and hearing loss (15%).